Hernia repair is a relatively straightforward surgical procedure, the ultimate goal of which is to restore the mechanical integrity of the abdominal wall by repairing a muscle wall defect through which an underlying section of the peritoneum and possibly part of the underlying viscera has protruded. There are various types of hernias, each with its own specific surgical repair procedure, including ventral hernias, umbilical hernias, incisional hernias, sports hernias, femoral hernias, and inguinal hernias. It is believed that most hernias are attributable to a weakness in sections of the tissues of the abdominal wall.
Even though the commonly used, conventional surgical procedures for correcting or repairing the various types of hernias are somewhat specific, there is a commonality with respect to the mechanical repair. Typically, the protrusion of the peritoneum through a muscle or abdominal wall defect results in a hernia sack containing the underlying and protruding viscera. In these procedures, the hernia sack is dissected and the viscera are pushed back into the abdominal cavity. Then, a tissue reinforcing or repair implant, such a mesh patch device, is typically implanted and secured at the site of the abdominal wall defect. Autologous tissue quickly grows into the implant, providing the patient with a secure and strong repair. In certain patient presentations, it may be desirable to suture or otherwise close the defect without an implant, although this is typically much less desirable for an optimal outcome.
One common type of hernia is a ventral hernia. This type of hernia typically occurs in the abdominal wall and may be caused by a prior incision or puncture, or by an area of tissue weakness that is stressed. There are several conventional repair procedures that can be employed by the surgeon to treat such hernias, depending upon the individual characteristics of the patient and the nature of the hernia. An often used technique is the implantation of a tissue repair implant in the intra-peritoneal location. This can be done via an open approach or a laparoscopic approach. The tissue repair implant, for example, a mesh patch, is inserted into the patient's abdominal cavity through an open anterior incision or via a trocar and positioned to cover the defect. The surgeon then fixates the mesh implant to the abdominal wall with conventional mechanical fixation or with sutures placed through the full thickness of the abdominal wall. There are a variety of such mechanical fixation devices that can be used in laparoscopic or open surgery, e.g., surgical tacking instruments.
Intraperitoneal placement of a mesh implant via an open approach may be the desired technique of repair where, for example, the layers of the abdominal wall are attenuated and a laparoscopic approach is not desired. Although such tissue repair patch implants exist and are commonly utilized for open ventral hernia repairs, there are deficiencies known to be associated with their use. The deficiencies include difficulty in handling the implants, poor visibility during handling, implantation and fixation, challenging usability and ergonomics when using a laparoscopic instrument for fixation to tissue. The commercially available tissue repair patch implants for this application typically have at least dual layers of mesh or fabric with pockets or skirts to provide for affixation to the parietal wall via the top layer or skirt. Such implants typically have a barrier layer of anti-adhesion material on the bottom viscera-facing side of the implant.
One problem associated with skirted or pocketed mesh implants for use in open ventral hernia repair procedures involves the position of the skirt or top layer when the surgeon applies surgical tacks to affix the mesh implant to the parietal wall. Since in an open procedure the surgeon typically cannot directly view the outer periphery of the skirt and the outer periphery of the bottom base layer of the implant during affixation with a conventional hernia tacking device, it is possible for a section of the skirt or top layer of the device to roll when the distal end of the tacking instrument is positioned in a pocket formed between the skirt and the top surface of the base member, causing a section of the skirt to move beyond the outer periphery of the base member. This may result in a poor repair having an inferior outcome since one or more sections of the implanted mesh may become distorted, for example wrinkled or separated from the peritoneum, possibly preventing proper tissue incorporation and also resulting in complications such as a recurrence of the hernia, surgical adhesions, etc. In addition, a section of the surface of the skirt extending beyond the periphery of the base member may come into contact with the patient's viscera, possibly causing irritation and the formation of surgical adhesions.
Accordingly, there is a need in this art for novel tissue repair implants, such as ventral hernia repair patch implants, that can be used in an open surgical procedure, and which can be affixed to tissue by a surgeon to repair a body wall defect with minimal or no mechanical distortion of the implant.